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February 9, 2010

How did Bertrand break his arm?

We've been getting that question a lot.

I wish we had an answer. At the moment, all we have are hypotheses.

For starters, we don't even know for sure when the break happened. Our best guess is that it happened with the spill he took out of his stander on Saturday morning. But, that spill was nothing compared with the kinds of spills "normal" kids have all the time. He's certainly had a couple harder falls than that. Moreover, he fell straight back (not on his arm) and there were no bumps, bruises, swelling or even redness. Even now, there are no external signs of trauma or injury.

With Bertrand, the only way to tell that he's injured is that he's more upset than normal. He already hates having his arms touched, so it probably took us a while to realize something was wrong. We started to notice increased seizures and abnormal sensitivity to his right arm Sunday night. He normally doesn't cry while changing clothes, but Sunday night, he did. Before that, we can't recall any signs.

At the moment, a bone lesion or cyst is the best candidate to explain how the break happened. Both are common in rapidly growing children or young adults on the long bones of the arms and legs--the top of the humerus is perhaps the most common location. The ER doc explained that bone lesions weaken bone strength, and make fractures much easier. In the worst case, it is possible that Bertrand is developing bone lesions as a result of his condition. The ketogenic diet can also deplete calcium and vitamin D, which makes bones more brittle, however it does not cause bone lesions. So far, his labs show no problems with either calcium or vitamin D.

Bertrand has also had more tonic seizures than normal since last Thursday. It is conceivable that a particularly strong tonic seizure could break a bone weakened by a cyst or lesion.

The fracture also hit his growth plate, but not severely enough to affect growth, according to the docs.

It's been unnerving for us to think that we may have let poor little Bertrand suffer, and it's really disturbing that we don't know how this happened. We are worried that if was a combination of tonic seizures and bone lesions, this could be the first break of more to come.

In the mean time, Bertrand won't be doing any physical or occupational therapy for two weeks, since much of it now revolves around getting him to use his arms properly. We'll shift the focus to cognitive and speech tasks instead.

Tomorrow, he's seeing the bone lesion specialist to investigate the bone lesion/cyst problem more thoroughly, and we'll report back what we learn.

Poor thing! Kids their age have such delicate bones, that sometimes it doesn't take much to brake them. When my neice and nephew (now 21yo) were about 2yo, they both climbed a dresser and it fell on them. My neice broke her arm and my nephew was unscathed. That was the only time she ever broke a bone.

I hope that this is the only time for Bertrand also. My fingers are crossed!

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